Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 1489 | NM |
Y | 213EG0000X | General Practice | 1489 | NM |
NPI | 1003905324 |
---|---|
Provider Name | Dr. Hunter Lee Mortley |
First Address | Albuquerque, NM 87109-1500 |
Second Address | Albuquerque, NM 87109-1500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |